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Boston Globe

Deadly fire prompts scrutiny of assisted living homes that serve lower income adults

More than 75 percent of Gabriel House residents are enrolled in Medicaid, state officials have said, and it charges significantly less than a typical assisted living facility does for private-paying patients. Built in 1964, Gabriel House had been the subject of several complaints from family members about living conditions. Lipson, secretary of the Executive Office of Aging and Independence, or AGE, raised the possibility that such facilities, because they are so dependent on government housing or Medicaid payments, 'should be regulated or supported in a different way' from those that rely on private payers. Advertisement There are about 20 affordable assisted living homes in Massachusetts, said state Representative Thomas Stanley, the Waltham Democrat who sponsored legislation to improve conditions in assisted living facilities last year. He said lower income adults are particularly ill-served by the current regulatory structure. Advertisement 'What needs to happen is a deep dive into the affordable ALR (Assisted Living Residence) model,' Stanley said. 'That fire probably would have never happened in one of the private pay ALRs because they're modern buildings.' Such facilities primarily rely on public subsidies to operate. That can include housing subsidies and support from Medicaid for some services. Gabriel House accepted payments through Massachusetts' Group Adult Foster Care program, which provides personal care assistance designed to keep people out of nursing homes. 'Unless Massachusetts can get more Medicaid funding for assisted living, there is not a model that works well for low income people,' said Liane Zeitz, a member of the state commission and an elder law attorney, after the meeting. Each year more elders in Massachusetts fall into a growing gap: they don't have enough medical needs to qualify for nursing home care, but can't afford assisted living or home care services, said Michelle Woodbrey, co-owner of 2Sisters Senior Living Advisors, which works with families across New England. 'When someone's care needs increase, they have to leave assisted living and move to a nursing home for help with multiple activities of daily living,' she explained. 'But someone can't just move into a nursing home because they're out of money. There's this group of people who fall between the cracks. Gabriel House served many of those people.' The median monthly cost of assisted living facilities in Massachusetts is $3,655 to $8,036, according to AGE. Gabriel House charges $2,400 a month for assisted living in a studio apartment. The owner of Gabriel House, Dennis Etzkorn, did not return a request for comment. He is listed as the principal for two corporations in state records, Advertisement Yet public subsidies may not be able to keep up with the cost of services, state officials said. Affordable assisted living homes are often in older, repurposed buildings, Stanley said. Such buildings are likely grandfathered through some code enforcement requirements, Stanley said. Fall River officials could not be reached Tuesday evening to clarify whether Gabriel House was exempted from building or fire code requirements. Nancy Jones, 68, a retired social worker, moved her sister, Donna Murphy, 73, into Gabriel house about five years ago. It was the only 'foster group home' they could afford, she said. 'They don't charge you as much,' she said. 'Any other assisted living is thousands of dollars.' She was shocked when, two days later, all of the cereal and perishables in Murphy's apartment had been eaten by mice, she said. She called the Fall River Public Works office, which told her they were aware of 'infestations' from mice and cockroaches and the facilities were being exterminated monthly. The door in the back of the building, which was locked, had a wheelchair accessible ramp and a bell that was supposed to let staff know when a resident wanted to come inside. The bell broke, Jones said, and even when it worked, it was difficult for wheelchair users to access. She contacted a state assisted living ombudsman, Steven Ellsweig, who visited the facility. Within two days the bell was fixed, Jones said. Advertisement Still, the larger problem of access to the door was never fixed, Jones said. The family called the ombudsman three additional times to report the facility's elevator was broken, which seriously limited Murphy's ability to get around. 'You knew something had to happen in this place,' she said. 'It was an accident waiting to happen.' Ellsweig did not respond to requests for comment. Carolyn Fenn, state ombudsman and director of the Long-Term Care Ombudsman Program, declined to comment on the number of complaints from Gabriel House or other homes. Compared to heavily regulated nursing homes, state oversight of assisted living facilities is limited, experts said. Fire safety issues appear to largely be left to municipal code enforcement. Workers have told the Globe there weren't fire drills at Gabriel House, but Fall River Fire Chief Jeffrey Bacon said his department's inspections do require buildings to have an evacuation plan and fire drills. 'And we would hold them to that, and hold them to giving us dates when they were performed,' he said. The group that met Tuesday, the Assisted Living Residence Commission, was created by long term care legislation passed last year. It has primarily focused on affordability and transparency within the larger assisted living industry, and safety issues weren't supposed to be a primary focus. Draft recommendations the commission plans to send to the Legislature next month include providing low income residents more help to access assisted living facilities, more clarity about costs, and greater public access to state records about the homes. Even some of these recommendations, though, received pushback from industry representatives. Staffing requirements for assisted living facilities are virtually nonexistent. But Brian Doherty, president of the industry trade group the Massachusetts Assisted Living Association, resisted suggestions for minimum staffing standards. Advertisement 'Because residences serve different acuity levels, there is no one-size-fits-all staffing ratio,' he posted in comments during the virtual meeting. Zeitz, the elder law attorney, wrote during a virtual meeting of the commission, 'There needs to be a method by which AGE can appropriately monitor and assess whether there is appropriate staffing. The Fall River case is an example. I understand that there were only 2 overnight staff on duty (and I'm not clear if they were required to be awake). Given the size of the building — this appears to have been inadequate.' Jason Laughlin can be reached at